Conflicts of Interest Disclosure · Child has an emotional need ... Turn to parent for protection Child’s fears are ... Between parent and child: The bestselling classic that revolutionized

2/19/2020

©ABFT Training. Please do not reproduce without permission. 1

Building Resiliency: The Role Attachment‐Based Family Therapy Can Play in Treating Youth

Suicide and Depression

Conflicts of Interest Disclosure

Dr. Suzanne Levy has received salary support via grants from the National Institute of Mental Health, American Foundation for Suicide Prevention, royalties from Attachment‐Based Family Therapy (ABFT; 2014) book sales and honoraria and salary support for ABFT trainings and supervision.

Center for Family Intervention ScienceABFT Training Program

Guy Diamond, Ph.D., Director‐ Center for Family Intervention Science, Associate Professor, College

of Nursing and Health Professionals, Drexel University

Gary Diamond Ph.D., ‐ Professor and Chair of the Department of Psychology, Ben Gurion University, Israel; http://www.bgupsychotherapyresearch.org/

Suzanne Levy, Ph.D., Training Director‐ ABFT Training Program, Drexel University, College of Nursing and Health Professions ([email protected])

Websites

www.ABFTtraining.com/www.Drexel.edu/abft

www.facebook.com/Attachment.Based.Family.Therapy

Follow us on Twitter and Instragram (@ABFTtraining) and Youtube

ABFT Belgium Training Center: https://ppw.kuleuven.be/ogop/abft

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Adolescent Suicide Statistics

• Endorse feeling sad or depressed most days in the past year38%

•Seriously considered attempting suicide16%

•Reported making a suicide attempt10%

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Among middle and high school students (Pennsylvania’s Office of the Governor, 2018 ):

Overview of ABFT

Brief Treatment

Developed for: Depressed and Suicidal youth

5 distinct, yet interrelated tasks

Manual, focused but flexible

Aims to build family as a resource for the suicidal teen

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Theory of Healthy Functioning

Secure Attachment (Bowlby, 1969)

Child has an emotional need

Caregivers are available,

responsive and attuned

Child feels loved and protected by

parents

Child believes they are worthy of

love and protection

Child more likely to seek support and feel safe to explore the world

Working model/Schema

Development of Emotion Regulation (Eisenberg et al., 2010)

Attachment Need Activated

Turn to parent for protection

Child’s fears are calmed

Self‐soothinginternalized

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Parenting Skills that Promote Attachment and Affect Regulation (Ginott, 2009; Gottman et al., 1997; 2011)

Acceptance of negative emotion

Validation of emotional experience

Help adolescent develop an emotional vocabulary

Parental expression of emotion

Conflicts resolved through negotiation and compromise

Authoritative Parenting(Baumrind, 1989)

Warmth Structure

Cross cultural support: contextual modifications (e.g., urban, low SES)

vs

Warmth

Structure

Warmth

Structure

Attachment in Adolescence

(Allen & Land, 1999, Steinberg, 1990)

Context: Supportive and respectful adolescent‐parent relations

Central task: Develop autonomy and maintain attachment

Moderate conflict: Facilitates identity development

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Family as protective factor(Kaslow, et al., 1994; Restifo & Bogels, 2009)

Parental Warmth

Parental Sensitivity

Better adolescent functioning and lower depression

Theory of Pathology

Insecure Attachment (Bowlby, 1969)

Child has an attachment need

Caregiver fails to be available, responsive and/or attuned

Child feels unprotected and unloved

Child develops low expectation of caregiver’s availability for support and

protection

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Attachment Style and Parenting (Jones, Cassidy, & Shaver, 2015)

Risk Factors for Insecure Attachment

Life Events/Trauma

Caregiver Stress

Family Interaction Patterns

Child Factors

Attachment‐Based Theory:Adolescent Depression and/or Suicide

Insensitive Caregiving

Attachment Ruptures

Depression and/or Suicide

ADOLESCENT PARENT

Insecure Attachment Style

Emotional Dysregulation Psychopathology

Intergenerational Attachment Patterns:

Conflict over Attachment and

AutonomyCurrent Stressors

Other contributing

factors

Feeling unworthy of love and protection

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Family as Safety Net

Strengthening families

Empirical Support

ABFT has shown to be effective with depressed and/or suicidal adolescents in 6 studies (Diamond et al., 2016)

Promising Practices Network: Proven practice

NREPP: Effective for depression and suicidal ideation

California Evidenced-Based Clearinghouse for Child Welfare (CEBC): “Promising Research Evidence” for adolescent depression

Swedish Guidelines for treatment of Depression

CYP IAPT recommended treatment in England

Dissemination EffortsInternationally in: Nationally in:

• Australia• Belgium • Canada• Croatia• England• Germany• Iceland• India• Ireland• Israel• Italy• Netherlands• Norway• Sweden• Turkey

• Arkansas• California• Colorado• Connecticut• Delaware• Georgia• Illinois• Indiana• Kansas• Maine• Maryland• Massachusetts

• Minnesota • Missouri• Nebraska• New Jersey• New York• North Carolina• Oregon• Pennsylvania• Texas• Utah• Virginia• Washington D.C

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Clinical Model

Five Treatment Tasks

Relational Reframe

Adolescent Alliance

Parent Alliance

Attachment

Promoting Autonomy

Task 1: Relational Reframe

Goal

Shift from patient as the problem to family relationships as the solution

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Highlight: ruptures and consequences• “When you are feeling so sad or afraid, why don’t

you go to your mom or dad for support?”

• “What’s the impact of dealing with issues all alone?”

Responsibility of change on all family members


Establish a treatment contract: Relationship repair

Task

Task 1 Video

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Task 2: Alliance with Adolescent

Bond

Meet alone with the adolescent

Alliance with adolescent


Coherent

Attachment

Narrative

Breaches of Parental Trust

Related Primary emotions

Impact of Ruptures

Attachment

Themes

Mental Health

Problem Narrative

Amplify Entitlement

Goal

Examples of RupturesTraumatic Events • “My mom didn’t protect me when dad was

abusing us. How can I trust her now?”

Negative family interactions• “My dad does not accept me.”• “My mom is critical and controlling.”• “My parents don’t understand me and try to

solve my problems.”

Parental psychopathology• “My mom freaks out (anxious) when I tell her my

problems.” • “I don’t want to burden my mom, she has

enough on her plate.”30

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Prepare adolescent for attachment task

Task 3: Alliance with Caregiver/Parent

Bond

Meet alone with the caregiver(s)

Determine who comes to the session.


Activate caregiver’s caregiving instinct.

Goal

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“It must be hard raisingan adolescent, let alone a depressed one when you are juggling so much. How has that impacted you?”

“Nobody was there for you when you were growing up, and now you don’t know how to be there for your son”


Prepare adolescent for attachment task

Emotion Coaching: The Five Steps

Be aware of a child’s emotions

Recognize emotion as a chance to get closer

Help child label emotions

Listen empathetically and validate child’s feelings

Begin problem‐solving only after child feels understood

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Guidelines for Dealing with Suicidal Adolescents (adapted from Brown et al.,2001)

Be very attentive, not detached

Remain calm and non‐threatened

Give the adolescent space and time to express themselves

Be willing to say the word “suicide” without flinching

At all costs, do not express anger, exasperation, or passive hostility

Do not immediately suggest hospitalization

Task 4: Attachment Task

Goal

Conversations about core attachment

ruptures

Resolves Conflicts

Begins to change relational expectations

Adolescent practices conflict resolution and emotion

regulation skills

Caregivers practice emotionfocused caregiving skills

Task 4: Attachment Task

Process

Adolescent discloses and

discusses ruptures

Caregiver(s) offer empathy and

acknowledgment

Therapist redirects as needed

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Task 4 Video

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Task 5: Autonomy Promoting Task

Goal

Revitalize a goal corrected partnership

Cooperation from desire

for connection

Caregivers viewed as

secure base

Task 5: Autonomy Promoting Task

Content of

Sessions

Factors contributing to depression and suicide

Emerging Maturity in

home

Build Competency

Identity Development

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Closing Statements

ABFT is all about relationship building!

Focusing conversations on the relationship is more engaging for the family

Caregivers play an essential role in helping their teens cope with depression and suicidal thoughts.

• Your adolescents need you, even if they do not show it

• Sometimes kids just need to be heard and not helped

• Find the right balance of warmth and structure

For more information:

Please contact: Suzanne Levy at [email protected]/abft

References • Allen, J. P., & Land, D. (1999). Attachment in adolescence. In Cassidy, Jude (Ed);

Shaver, Phillip R. (Ed). (1999). Handbook of attachment: Theory, research, and clinical applications (pp. 319‐335). New York: Guilford Press

• Baumrind, D. (1989). Rearing competent children. In W. Damon (Ed.), The Jossey‐Bass social and behavioral science series. Child development today and tomorrow (p. 349–378). Jossey‐Bass.

• Brown, G. K., Bruce, M. L., & Pearson, J. L. (2001). High‐risk management guidelines for elderly suicidal patients in primary care settings. International Journal of Geriatric Psychiatry, 16, 593‐601.

• Bowlby, J. (1969). Attachment and Loss. New York: Basic Books

• Diamond, G.S.; Diamond, G.M.; & Levy, S.A. (2014). Attachment‐Based Family Therapy for Depressed Adolescents. American Psychological Association

• Diamond, G., Russon, J. & Levy, S. (2016), Attachment‐Based Family Therapy: A Review of the Empirical Support. Family Process, 55(3), 595‐610. doi:10.1111/famp.12241

• Eisenberg, N., Spinrad, T. L., Eggum, N. D., Silva, K. M., & Reiser, M. (2010). Relations among maternal socialization, effortful control, and maladjustment in early childhood. Development and Psychopathology, 22(3), 507‐525. doi: 2110/10.1017/S0954579410000246.

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References Cont’d• Ginott, H. G. (2009). Between parent and child: The bestselling classic that

revolutionized parent‐child communication. Crown Archetype.

• Gottman, J (2011). Raising an emotionally intelligent child. Simon & Schuster. NY: NY

• Gottman, J.M., Katz, L.F., & Hooven, C. (1996). Parental meta‐emotion philosophy and the emotional life of families: Theoretical models and preliminary data. Journal of Family Psychology, 10(3), 243‐268

• Jones, J. D., Cassidy, J., & Shaver, P. R. (2015). Parents' self‐reported attachment styles: a review of links with parenting behaviors, emotions, and cognitions. Personality and social psychology review : an official journal of the Society for Personality and Social Psychology, Inc, 19(1), 44–76. https://doi.org/10.1177/1088868314541858

• Kaslow, N. J., Deering, C. G., & Racusin, G. R. (1994). Depressed children and their families. Clinical Psychology Review, 14, 39‐59.

• Pennsylvania Office for the Governor (2018). School Safety Task Force Report [PDF file]. Retrieved from https://www.governor.pa.gov/wp‐content/uploads/2018/08/20180827‐Gov‐Office‐School‐Safety‐Report‐2018.pdf

• Restifo, K., & Bogels, S. (2009). Family processes in the development of youth depression: translating the evidence to treatment. Clinical Psychology Review, 29(4), 294‐316.

• Steinberg, L (1990). Autonomy, conflict and harmony in the family relationships. In S.S. Feldman and G.R. Elliot (Eds.). At the threshold: the developing adolescent, (pp. 255‐276). Cambridge Mass; Harvard University Press.

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Documents

Conflicts of Interest Disclosure · Child has an emotional need ... Turn to parent for protection Child’s fears are ... Between parent and child: The bestselling classic that revolutionized